We hope that you are having a festive, relaxing holiday season. Here’s what our team is up to:
Zach: Oh, where to start? There are so many things, so I’ll just pick one. I love the lights. We’re fortunate to live in a neighborhood where people get very into the holidays, and it’s fun to drive around and see what folks have come up with. My husband and I also like to decorate, and we’ve (maybe) gone a little overboard this year :)
Sarah: My favorite part of the holidays is the overall joyfulness I feel when I am spending time with the people I love so dearly. The season brings a lot of comfort and coziness for me with decorations, smells, gifts, and dedicated time to spend with those I love.
Crystal: When I think about the upcoming holidays drawing near, excitement fills my heart. I will spend quality time with my family and friends in a few short weeks. Throughout the year, everyone is so busy, but during the holidays, everyone will slow down enough to enjoy some memorable moments. It is a time of year I will have all three of my boys under one roof for a whole week. Then the night before Christmas, my extended family and friends will gather at my sister’s house. It is a time that I catch up with my aunts, uncles, cousins, sisters, nieces, nephews and friends. The highlight of the night is when Santa makes a surprise visit before he heads out to deliver the gifts to all the children.
Brady: I love taking time to relax, rest, and gather with family and friends. I also really enjoy getting a Christmas tree each year. My dad is allergic to pine, so we grew up with an artificial tree. Now, every year my fiancé and I get a real tree, and I love the smell of pine throughout our house!
Zach: My husband and I like to choose a special cause to donate to every year, and it’s fun to find something we’re both passionate about where we can help.
Sarah: My sister’s birthday is Christmas Eve; she lives her whole year looking forward to her birthday, so we celebrate her on Christmas Eve- it’s my favorite day of the year. Her joy is infectious and on her birthday, her cup overflows with so much joy — it’s truly the best.
Crystal: A holiday tradition that I cherish is going to my dad’s house for breakfast on Christmas morning. On Christmas morning, everyone wakes up to Santa’s surprises. After everyone discovers what Santa left for them, my four sisters and their families, along with my family (a total of 22), travel to my dad and stepmother’s house. We go in our pajamas and, of course, freshly brushed teeth. My dad demonstrates his cooking skills in front of all the kids and grandkids by throwing eggs up in the air to flip them to the other side. The kids love it! I love this time because we spend quality time with my family while enjoying fantastic food.
Brady: My favorite tradition is Christmas morning breakfast with my family—actually, the entirety of Christmas day. The whole family gets together on Christmas morning for steak and eggs. I try and eat a mostly vegetarian diet throughout the year, so the Christmas morning “cheat day” is extra special. Then, in the evening we all gather again at my grandparent’s house for a very eclectic Christmas dinner. We like to joke that anyone my grandmother happens to meet that week at the grocery store is invited. It’s an all-around great time with family and friends, and I always seem to meet someone new!
Zach: I’m excited about opportunities to continue advancing access and equity in oral health care across North Carolina. I’m really passionate about the work we’re doing at NCOHC and FHLI, and there’s a lot of positive momentum right now. I’m also hopeful that more people will get vaccinated!
Sarah: I am looking forward to a year full of more and more hugs! As I think about the new year and what that means to me, I reflect upon the lessons and gifts of the previous year while being hopeful for joy-filled days ahead. In 2022, I am really looking forward to my upcoming wedding and spending those special moments with my partner and those who love us!
Crystal: NCOHC had a lot of success creating system change for oral health care access in 2021. As a new addition to the NCOHC team, I am looking forward to working on various initiatives and seeing what NCOHC accomplishes in 2022. Personally, I am excited to see my son, Chase, graduate high school in 2022 and see where life takes him.
Brady: I have so much to look forward to in 2022, both in my personal and professional life! I’m excited to see the ways that NCOHC can leverage the work we did this year to create more positive change for folks across North Carolina.
On Nov. 18, Governor Roy Cooper signed the 2021 North Carolina state budget into law, the first budget the state will have since 2018.
There are many reasonable provisions in this year’s budget — thanks to American Rescue Plan funds, an historic amount of money has been allocated to improve the lives of North Carolinians. There are other provisions that were unfortunately left out as well, most importantly from a public health perspective being full Medicaid Expansion.
At NCOHC, our staff has been focused on one particular provision: expansion of the Medicaid for Pregnant Women program to one year postpartum (after birth).
Earlier this year, one of NCOHC’s fantastic interns, Hannah Archer, wrote a policy brief outlining the benefits of expanding postpartum Medicaid services and analyzing its political feasibility.
The policy was originally proposed as a standalone bill by Senators Jim Burgin, Joyce Krawiec, and Kevin Corbin. It goes without saying that NCOHC was thrilled to see the policy incorporated into the 2021 budget.
The postpartum Medicaid service expansion will go into effect on April 1, 2022. After that date, North Carolinians with incomes up to 196 percent of the federal poverty level will be able to access Medicaid services for the duration of pregnancy and one full year after giving birth.
The policy, as laid out in the 2021 budget, is set to expire on March 31, 2027. NCOHC is fully confident that the benefits of the expansion will speak for themselves over the course of the next five years, and we look forward to working with stakeholders to make the policy a permanent change in the future.
It will be important to stay tuned as the postpartum Medicaid service expansion is implemented. Currently, the Medicaid for Pregnant Women program includes all medical services, including oral health. Under the current framework, traditional medical services are available for 60 days postpartum, while oral health services end at birth.
The text in the 2021 budget is broad, and language limiting coverage for services “related to pregnancy and to other conditions determined by the Department as conditions that may complicate pregnancy” is removed. This bodes well for oral health’s inclusion in the postpartum expansion (although we would also argue that the negative outcomes that result from a lack of oral health care absolutely fall into the category of conditions that could complicate pregnancy).
The details will be ironed out in the coming months, and we will be sure to keep you up to date on any news as it arises.
NCOHC is a program of the Foundation for Health Leadership & Innovation. To get involved, find out more information, and to stay up to date, head over to NC4Change to sign up for our newsletter and see what events and other opportunities are on the horizon.
On April 8, 2002, Ray Krone was released from prison after serving 10 years for a murder he did not commit.
A decade earlier, a woman’s body was found at the bar Krone frequented. Officers identified Krone as a person of interest, and they took a Styrofoam impression of his teeth to see if they matched bite marks on the victim’s neck.
Krone had distinctly crooked teeth, so after an American Board of Forensic Odontology-certified diplomate testified that Krone’s teeth were a match and he was convicted of the murder, he was dubbed the “Snaggle Tooth Killer.”
Years later, DNA evidence proved that Krone was not involved in the murder – the bite marks were not his.
Bite-mark analysis is used in courtrooms across America, and unfortunately, it is responsible for hundreds of years in wrongful convictions.
“There has been no scientific research that has adequately established basic premises in bite mark comparison work, including whether an examiner can even, with sufficient accuracy, identify a mark as a human-created bite, much less opine on whether a particular set of dentition produced that bite,” said Brandon Garrett, director of the Wilson Center for Science and Justice and the L. Neill Williams, Jr. Professor of Law at Duke University.
The Innocence Project has documented more than 30 instances of people wrongfully indicted or imprisoned in part due to the use of bite-mark analysis.
In total, more than 424 combined years of wrongful incarceration have been served as a result of these convictions.
In fact, bite-mark analysis is so unreliable that it has even been used to convict in cases where bites were later proven to be from animals, not humans.
Garrett mentioned a case in Mississippi in 1995 where Kennedy Brewer was given the death penalty after a bite-mark analysis linked him to marks left on a victim’s body. Years later, a reexamination led to the discovery that the 19 bite marks were actually the result of insect bites, not a human’s teeth. Brewer still served 15 years before his exoneration.
As it stands today, there is little, if any, scientific evidence in support of bite-mark analysis. Beyond that, dentists who serve as forensic odontologists do not have to demonstrate a level of proficiency in the matter at hand: linking marks on a human’s skin to the teeth in someone’s mouth.
“Local courts have even permitted local pediatric dentists and persons with no prior background in forensic work to testify,” said Garrett, adding that even odontologists with decades of experience have made testimony resulting in wrongful convictions. “It is not clear that experience over many years in a technique with unknown reliability makes one better than a novice; the technique may be so unreliable that experience is irrelevant.”
The issue of bite-mark analysis is a question of equity and social justice. As NCOHC and our partners work to increase access and equity in oral health care, it is worth considering this social injustice that so closely involves the dental community.
The number of dentists who serve as expert witnesses in the courtroom is small – and the number who provide bite-mark testimony is even smaller. Nevertheless, the impact, especially on those who have been wrongly convicted, is immeasurable.
Learn more: Brandon Garrett recently spoke in depth about bite mark analysis, other social justice issues that stem from forensic sciences, and his book, “Autopsy of a Crime Lab: Exposing the Flaws in Forensics” on the podcast Pod Save the People.
NCOHC is a program of the Foundation for Health Leadership & Innovation. To get involved, find out more information, and to stay up to date, head over to NC4Change to sign up for our newsletter and see what events and other opportunities are on the horizon.
The connection between oral health and overall health is increasingly clear, but you wouldn’t know it looking at the federal government’s Medicare program. Medicare, which provided health insurance for more than 62 million U.S. retirees and people with disabilities in 2020, does not include dental coverage — except in very limited circumstances.
Overall, according to a 2019 study by the Kaiser Family Foundation (KFF), 47 percent of Medicare beneficiaries do not have dental coverage. While some Medicare beneficiaries have a dental benefit through optional, add-on Medicare Advantage plans (with additional premiums and co-pays), the scope of coverage is often extremely limited. For much of the older adult population in the United States, oral health care services are simply unaffordable.
The lack of Medicare dental coverage and high out-of-pocket costs facing older U.S. adults with oral health needs represent a true public health emergency. Forty-seven percent of Medicare beneficiaries did not have a dental visit in the last year, according to the same KFF study. The impact is especially disproportionate for marginalized communities, with the percentage without a dental visit climbing to 68 percent for Black beneficiaries, 61 percent for Hispanic beneficiaries, and 73 percent for low-income beneficiaries. Other at-risk populations are similarly affected. Among Medicare beneficiaries in fair or poor health, for example, the number is 63 percent.
The consequences are as devastating as they are preventable. A study by KFF of the 2016 Medicare Current Beneficiary Survey (MCBS) found that among all Medicare recipients living in the community, “18 percent have some difficulty chewing and eating solid foods due to their teeth.” This includes 29 percent of low-income recipients and 33 percent of recipients with disabilities under age 65. Oral health conditions are also common among the Medicare population: over 14 percent of older U.S. adults have untreated dental decay (caries), and 68 percent have periodontal disease (gum disease).
Various studies have linked periodontal disease to systemic health problems like diabetes, heart disease, kidney disease, and cancer. Dr. Lisa Simon and Dr. William Giannobile said it well in a recent opinion piece appearing in the New England Journal of Medicine: “The key reason that access to dental care is crucial is that, even in the absence of other medical complications, dental problems are a preventable and far-too-common source of disabling disease.”
That reality is especially true for older adults. “Growing evidence shows that poor oral health can worsen health conditions disproportionately impacting older individuals such as diabetes and cardiovascular disease — conditions that Medicare does cover,” the National Dental Association stated in a September letter calling for the expansion of Medicare to include a dental benefit.
In the decades since Medicare’s establishment in 1965, advocates have continually pushed for expanding the program to include dental, hearing, and vision benefits. However, current political realities mean that reform is perhaps closer than ever before. Powerful interest groups nevertheless threaten to dramatically scale back or derail the proposed change.
Despite not necessarily opposing a dental Medicare benefit altogether, some interest groups are applying the brakes. Rather than make dental coverage universal for all Medicare recipients, some have endorsed a model in which Medicare dental benefits would be available only to beneficiaries whose incomes are 300 percent or less of the federal poverty level (FPL), equating to roughly $38,000 per year for an individual.
To be clear: this would be a mistake. “Means-testing” has never been used with other health coverage under Medicare and would represent a step in the wrong direction if applied to a new dental benefit.
By means-testing dental Medicare benefits, oral health care would remain out of reach for millions of working and middle-class older adults. That’s because out-of-pocket costs for dental care would still exceed many individuals’ available discretionary income, even for those earning more than 300% FPL. After all, KFF reports that out-of-pocket spending on dental care was $874 on average for Medicare beneficiaries using dental services in 2018 and that one in five Medicare beneficiaries using dental services spent more than $1,000 out-of-pocket. Many seniors, the majority of whom live on fixed incomes, simply cannot afford the out-of-pocket costs associated with routine, preventive dental care, to say nothing of more costly restorative or surgical procedures.
Beyond this inequity, however, means-testing dental benefits could potentially threaten the sustainability of the broader Medicare program. Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, noted in a recent op-ed that “If means-testing results in Medicare becoming increasingly unfair to higher-income beneficiaries, they may opt-out and purchase their policy on the private market. The departure of higher-income beneficiaries, who tend to be younger and healthier, would weaken the risk pool, putting additional strain on Medicare’s finances.” Further, as Richtman writes, applying the first-ever means-test to a Medicare benefit would set a dangerous precedent for future means-testing of other coverages.
Moreover, applying a means test to Medicare dental benefits would likely result in a situation in which a majority of private practice dentists decline to participate. We’ve seen this happen with Medicaid and the Children’s Health Insurance Program (CHIP). By limiting the potential pool of new patients, means-testing a Medicare dental benefit would similarly and significantly reduce the financial incentive for private practice dentists. According to the ADA Health Policy Institute (HPI), only 43 percent of dentists nationwide participate in Medicaid or CHIP, dramatically limiting access to care and fueling health disparities among disadvantaged populations. A means test applied to Medicare would almost certainly compound the problem.
Dental coverage under Medicare is sorely needed, but to make Medicare dental benefits anything but universal diminishes the message that public health-minded dentists have fought so hard to advance: that oral health is overall health. It also threatens to deepen inequities and deny care to at-risk populations that need it most. Congress should act now to expand Medicare to include dental coverage and reject misguided attempts to impose means-testing on potential beneficiaries.
Dr. Zachary Brian is the Director of the North Carolina Oral Health Collaborative (NCOHC) and VP of Impact, Strategy, and Programs for its parent organization, the Foundation for Health Leadership & Innovation (FHLI).